Healthcare Provider Details

I. General information

NPI: 1043398563
Provider Name (Legal Business Name): VETERANS ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

6714 EAST ST
MEDINA OH
44256-9103
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax:
Mailing address:
  • Phone: 330-723-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number03-3-14347
License Number StateOH

VIII. Authorized Official

Name: TIMOTHY LEE SILVA
Title or Position: STAFF PHARMACIST
Credential: R. PH.
Phone: 217-791-3800